Evolution of vascular grafts: From antiquity to the contemporary era

Vascular grafts represent an integral element of reconstructive cardiovascular surgery. The search for optimal plastic materials and the development of new vascular grafts remain pressing tasks of modern medicine. The historical path of vascular surgery encompasses the transition from implanting the first experimental tubular structures made of glass, bone, and metals to the creation of high tech synthetic, biological, and tissue-engineered grafts. This review presents the key stages of introducing vascular grafts into clinical practice, summarizes the results of preclinical and clinical studies, and outlines existinglimitations and unresolved issues. Particular attention is paid to the compliance of grafts with the biomechanical properties of native vessels, their thromboand immunoresistance, as well as their durability against infectious complications. Modern vascular grafts are examined separately, with analysis of their characteristics, advantages, and disadvantages. The prospects for creating small diameter vascular grafts are associated with the development of three-dimensional bioprinting technologies and the design of individualized grafts that closely approximate the structure and functional properties of the body’s natural tissues. For the preparation of this review, a systematic search was conducted in international electronic databases, including PubMed, Web of Science, and Embase, as well as in specialized resources such as the Cochrane Library and domestic electroniclibrary systems. The search was performed using the following keywords: vascular grafts, prosthetic vascular grafts, homografts, Dacron, PTFE, tissue engineering, and small-diameter vascular grafts. In total, 604 publications were identified. After analyzing titles and abstracts, 412 sources were selected for further consideration. Of these, 338 articles were excluded due to non-compliance with the inclusion criteria (lack of relevant historical data or duplication of material). Following the final eligibility assessment, 72 articles were included in the analysis. Of these, 5 publications were used in the preparation of the Introduction section, while the remaining 67 were employed in the development of the main sections of the study.

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